Hwang Jae Ha, Kim Kwang Seog, Lee Sam Yong
Assistant Professor, Department of Plastic and Reconstructive Surgery, Chonnam National University Medical School, Gwangju, Korea.
Professor, Department of Plastic and Reconstructive Surgery, Chonnam National University Medical School, Gwangju, Korea.
J Foot Ankle Surg. 2018 Jul-Aug;57(4):808-810. doi: 10.1053/j.jfas.2017.11.013. Epub 2018 Mar 21.
A 45-year-old male presented with amputation of posterior heel soft tissue after an accident involving broken glass panes. The defect measured 4 × 6.5 cm, and the composite amputated tissue consisted of skin and subcutaneous layers. Intraoperative exploration of the amputated tissue revealed 2 perforator arteries (diameter ≤0.4 mm) in the central portion of the subcutaneous tissue and 4 superficial veins (diameter ≈0.6 mm) in the wound margin. These vessels were anastomosed end-to-end to the corresponding vessels from the wound bed using 11-0 nylon sutures. The replanted tissue survived completely. The patient retained excellent aesthetic and functional outcomes at the 13-month follow-up visit. The present case serves to demonstrate the feasibility of microsurgical replantation for the posterior heel. Although such isolated amputations are far less common than digital amputations, our experience suggests that microsurgical replantation is indicated beyond the current spectrum of clinical repertoire.
一名45岁男性在涉及破碎玻璃板的事故后出现足跟后部软组织离断。缺损大小为4×6.5厘米，离断的复合组织包括皮肤和皮下层。术中对离断组织进行探查发现，皮下组织中央部分有2条穿支动脉（直径≤0.4毫米），创缘有4条浅静脉（直径≈0.6毫米）。使用11-0尼龙缝线将这些血管与创面床相应血管进行端端吻合。再植组织完全存活。在13个月的随访中，患者保持了极佳的美观和功能效果。本病例证明了足跟后部显微外科再植的可行性。尽管这种孤立性离断远不如手指离断常见，但我们的经验表明，显微外科再植超出了目前临床常规范围。
